Manufacturers of formula milk are
violating the international code of marketing of breast milk substitutes in west
Africa, say researchers in this week's BMJ.

Two survey teams monitored compliance with
the code, adopted by the World Health Assembly in 1981 to ensure the proper use
of breast milk substitutes. The study involved health facilities, sales outlets,
distribution points, and the news media in Togo (a country without legislation
on the marketing of breast milk substitutes) and Burkina Faso (which has such
legislation).

Violations included no statement on
superiority of breastfeeding, no instructions for appropriate preparation or
storage, no warning against health hazards of inappropriate use, and pictures,
drawings, or text idealising use.

The levels of code violations were similar
in both countries. Six (14%) health facilities had received donations of breast
milk substitutes. All donations were being given to mothers free of charge.
Health providers in five (12%) health facilities had received free samples of
breast milk substitutes and promotional gifts from manufacturers.

Promotional materials for commercial
breast milk substitutes were found in seven (16%) health facilities. Special
displays to market commercial breast milk were found in 29 (44%) sales and
distribution points.

Forty commercial breast milk substitutes
violated the labelling standards of the code: 21 were manufactured by Danone, 11
by Nestle, and eight by other national and international manufacturers. Most
health providers (90%) has never heard of the code, and 63% of mothers had never
received any counselling on breast feeding by their health providers.

Governments have an obligation to ensure
that legislation is accompanied by effective information, training, and
monitoring systems to ensure compliance with the code, say the authors.
Manufacturers have an obligation to comply with the standards of the code, they
conclude.

Protection of breast feeding from
commercial exploitation should be among the highest priorities for the
international community, write two paediatricians in an accompanying editorial.
They discuss how we should monitor compliance with the code, how we should train
health workers, and how we should combine support for breast feeding with a
recognition of the risk of maternally transmitted HIV infection.